Chapter 03: Life Span Considerations

Front 1

Definition: Active Transport

Back 1

The active (energy-requiring) movement of a substance between different tissues via a biomolecular pumping mechanism contained within cell membranes.

Hint 1

p. 36

Front 2

Definition: Diffusion

Back 2

The passive movement of a substance (e.g., a drug) between different tissues from areas of higher concentration to areas of lower concentration.

Hint 2

p. 36

Front 3

Definition: Elderly

Back 3

Pertaining to a person who is 65 years of age or older.

Hint 3

p. 40

Front 4

Definition: Neonate

Back 4

Pertaining to a person younger than 1 month of age; newborn infant

Hint 4

p. 36

Front 5

Definition: Pediatric

Back 5

Pertaining to a person who is 12 years of age or younger

Hint 5

p. 38

Front 6

enhanced blood flow to the fetus, increased fetal surface area, and increased amount of free drug in the mothers circulation.

Back 6

Although exposure of the fetus to drugs is most detrimental during the first trimester, drug transfer to the fetus is more likely during the last trimester. This is a result of...

Hint 6

p. 37

Front 7

first trimester,
because during this period the fetus undergoes rapid cell proliferation, and the skeleton, muscles, limbs, and visceral organs are developing at their most rapid rate.

Back 7

Which trimester imposes the greatest danger of drug induced developmental defects.

Hint 7

p.37

Front 8

diffusion

Back 8

Transfer of both drugs and nutrients to the fetus occurs primarily by _______ across the placenta.

Hint 8

p.36

Front 9

volume of milk consumed

Back 9

The actual amount of drug to which a breast-feeding infant is exposed depends largely on the...

Hint 9

p.37

Front 10

A --> 3
B --> 4
C--> 1
D --> 2

Back 10

Match the age range of young patients to their classifications.
(ex. a-3, b-4, etc..)
a. younger than 38 wk gestation
b.younger than 1 month
c. 1 mo up to 1 yr
d. 1 yr up to 12 yrs

1. infant
2. child
3. premature or preterm infant
4. neonate or newborn infant

Hint 10

p. 38 (table 3-2)

Front 11

1. gastric pH is less acidic because acid-producing cells in the stomach are immature until approximately 1 to 2 years of age
2. gastric emptying is slowed because of slow or irregular peristalsis
3. first-pass elimination by the liver is reduced because of the immaturity of the liver and reduced levels of microsomial enzymes.
4. intramuscular absorption is faster and irregular

Back 11

Pharmacokinetic changes in the neonate and pediatric patient during absorption include..
(try to list them on your own first, 4 things)

Hint 11

p. 38 (go back and review whole table)

Front 12

a.total body water is 70% to 80% in full-term infants
b. 85% in premature new borns
c. 64% in children 1-12 yrs of age

Back 12

For a pediatric patient during distribution the total body water in
a. full term infants
b. pre-mature new borns
c. children 1-12 yrs of age
is what?

Hint 12

p. 38

Front 13

1. skin is thinner and more permeable
2. stomach lacks acid to kill bacteria
3. lungs have weaker mucous barriers
4. body temperature is less well regulated and dehydration occurs easily
5. liver and kidneys are immature and therefore drug metabolism and excretion are impaired

Back 13

Give three examples of characteristics of pediatric patients that have a specific effect on dosage amount. (there are 5 total characteristics)

Hint 13

p.38

Front 14

body weight

Back 14

calculating the drug dosage according to ______ ______ is the most commonly used method today

Hint 14

p. 39

Front 15

anti-hypertensives, beta-blockers, diuretics, insulin, and potassium supplements

Back 15

Commonly prescribed drugs for the elderly include...

Hint 15

p.41

Front 16

analgesics, laxatives, and nonsteroidal anti-inflammatory drugs (NSAIDSs)

Back 16

Commonly used OTC drugs for the elderly include...

Hint 16

p. 41

Front 17

c. immaturity of neonatal organs

Back 17

Which physiologic factor is most responsible for the differences in the pharmacokinetic and pharmacodynamic behavior of drugs in neonates and adults?
a. infant's stature
b. infant's smaller weight
c. immaturity of neonatal organs
d. adult's longer exposure to toxins

Front 18

d. body weight

Back 18

Most drug references provide recommended pediatric dosages based on which of the following?
a. total body water content
b. fat-to-lean mass ratio
c. height
d. body weight

Front 19

b. on body weight and organ function

Back 19

When considering drug dosages in older patients, the nurse recognizes that drug dosages in older adults should be based on which factor?
a. more on age than on height and weight
b. on body weight and organ function
c. on the total body water content
d. the strength of the drug

Front 20

b. gastric pH is less acidic because of reduced hydrochloric acid production c. protein albumin binding sites are reduced because of decreased protein d. fat content is increased because of decreased lean body mass

Back 20

When giving medications to older adults, the nurse should keep in mind the changes that occur due to aging. Which statements regarding changes in the older patient are true? (select all that apply)
a. total body water content increases as body composition changes
b. gastric pH is less acidic because of reduced hydrochloric acid production
c. protein albumin binding sites are reduced because of decreased protein
d. fat content is increased because of decreased lean body mass
e. the absorptive surface area of the gastrointestinal tract is increased due to flattening and blunting of the villi

Front 21

TRUE

Back 21

TRUE or FALSE
The collective physiologic changes associated with the aging process have a major effect on the disposition and action of drugs.

Hint 21

p.41

Front 22

1. low cardiac output = low absorption and distribution
2. low blood flow = low absorption and distribution

Back 22

Names a physiologic change associated with the cardiovascular system in elderly patients.

Hint 22

p.42 (table 3-3)

Front 23

1. high pH (alkaline gastric secretions = altered absorption)
2. low peristalsis = delayed gastric emptying

Back 23

Name a physiologic change associated with the gastrointestinal system in elderly patients.

Hint 23

p. 42 (table 3-3)

Front 24

1. low enzyme production = low metabolism
2. low blood flow = low metabolism

Back 24

Name a physiologic change associated with the hepatic system in elderly patients.

Hint 24

p.42 (table 3-3)

Front 25

1. low blood flow = low secretion
2. low function = low excretion
3. low glomerular filtration raye = low excretion

Back 25

name a physiologic change associated with the renal system in elderly patients.

Hint 25

p.42 (table 3-3)

Front 26

primarily due to decresed blood flow

Back 26

Why is glomerular filtration decresed by 40-50% in older adults?

Hint 26

p.42

Front 27

Endema, nausea, abdominal distress, gastric ulceration, bleeding, and renal toxicity

Back 27

NSAID's (nonsteroidal antiinflammatory drugs) may cause what types of common complications?

Hint 27

p.43 (table 3-4)

Front 28

anticoagulant

Back 28

Heparin and warfarin are what type of medication?

Hint 28

p.43 (table 3-4)

Front 29

Analgesics

Back 29

What type of medication has the following common complications,
confusion, constipation, urinary retention, nausea, vomiting, respiratory depression, decreased level of consciousness, falls

Hint 29

p.43 (table 3-4)

Front 30

COPD (chronic obstructive pulmonary disease)

Back 30

What are the following drugs used to medicate, long-acting sedatives or hypnotics, narcotics, beta-blockers.

Hint 30

p. 43 (table 3-4)

Front 31

A. immature renal system

Back 31

The nurse is reviewing factors that influence pharmacokinetics in the neonatal patient. Which factor puts the neonatal patient at ridk with regard to drug therapy?
a. immature renal system
b. hyperperistalsis in the GI tract
c. irregular temperature regulation
d. smaller circulatory capacity

Front 32

D. water composition of approximately 75%

Back 32

The physiologic differences in the pediatric patient campared with the adult patient affect the amount of drug needed to produce a therapeutic effect. The nurse is aware that one of the main differences is that infants have
a. increased protein in circulation
b. fat composition lower than 0.001%
c. more muscular nosy composition
d. water composition of approximately 75%

Front 33

C. Decreased blood flow to the liver, resulting in more adverse effects

Back 33

While teaching a 76-year old patient about the adverse effects of his medications, the nurse encourages him to keep a journal of the adverse effects he experiences. This intervention is important for the elderly patient because of alterations in pharmacokinetics, such as
a. increased renal excretion of protein- bound drugs.
b. more alkaline gatric pH, resulting in more adverse effects
c. decreased blood flow to the liver, resulting in altered metabolism
d. less adipose tissue to store fat-soluble drugs

Front 34

a. immature renal system

Back 34

The nurse is reviewing factors that influence pharmacokinetics in the neonatal patient. Which factor puts the neonatal patient at risk with regard to drug therapy?
a. immature renal system
b. hyperperistalsis in the GI tract
c. irregular temperature regulation
d. smaller circulatory capacity

Front 35

d. water composition of approximately 75%

Back 35

The physiologic differences in the pediatric patient compared with the adult patient affect the amount of drug needed to produce a therapeutic effect. The nurse is aware that one of the main differences is that infants have
a. increased protein in circulation
b. fat composition lower than 0.0001%
c. more muscular body composition
d. water composition of approximately 75%

Front 36

d. less adipose tissue to store

Back 36

While teaching a 76 year-old patient about the adverse effects of his medications, the nurse encourages him to keep a journal of the adverse effects he experiences. This intervention is important for the elderly patient because of alterations in pharmacokinetics, such as
a. increased renal excretion of protein-bound rugs
b. more alkaline gastric pH, resulting in more adverse effects
c. decreased blood flow to the liver, resulting in altered metabolism
d. less adipose tissue to store fat-soluble drugs

Front 37

d. anti-hypertensives

Back 37

when the nurse is reviewing a list of medications taken by an 88-year0old patient, the patient says,"I get dizzy when i stand up." she also states that she has nearly fainted "a time or two" in the afternoons. Her systolic blood pressure drops 15 points when she stands up. Which type of medication may be responsible for these effects?
a. NSAIDs
b. cardiac glycosides
c. anticoagulants
d. anti-hypertensives

Front 38

d. "studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed, if you need it."

Back 38

A pregnant patient who is at 32 weeks gestation has a cold and calls the office to ask about taking an OTC medication that is rated as pregnancy category A. Which answer by the nurse is correct?
a. "this drug causes problems in the human fetus, so you should not take this medication"
b. " this drug may cause problems in the human fetus, but nothing has been proven in clinical trials. It is best not to take this medication"
c. "this drug has not caused problems in animals, but no testing has been done in humans. It is probably safe to take"
d. "studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed, if you need it."

Front 39

b. provide a brief, concrete explanation about the injection
d. make use of magical thinking
e. provide comfort measures after the injection

Back 39

The nurse is preparing to administer an injection to a preschool aged child. Which approaches are appropriate for this age group? (select all that apply)
a. explain to the child in advance about the injection
b. provide a brief, concrete explanation about the injection
c. encourage participation in the procedure
d. make use of magical thinking
e. provide comfort measures after the injection